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  • Question 1 - The blood test reports of a 56-year-old female are sent for your review....

    Correct

    • The blood test reports of a 56-year-old female are sent for your review. She seems acutely sick and has had multiple infections over the past few months. Her complete blood count report shows neutropenia.

      Which one of the following options is true with regards to neutropenia?

      Your Answer: It can be caused by both radiotherapy and chemotherapy

      Explanation:

      A total neutrophil count of less than 2 x 109/L is defined as neutropenia. It can be caused by the following:
      1. viral infections
      2. SLE
      3. RA
      4. hypersplenism
      5. chemo- and radiotherapy
      6. vitamin B12 and folate deficiency
      7. drug reactions

    • This question is part of the following fields:

      • Haematology
      • Pathology
      32.4
      Seconds

  • Question 2 - A 57-year-old woman has presented with cough and shortness of breath. Her GP...

    Correct

    • A 57-year-old woman has presented with cough and shortness of breath. Her GP had done some blood tests recently and told her that she had a positive ANA result.

      Which of these statements is true about anti-nuclear antibodies (ANAs)? Select only ONE answer.

      Your Answer: The presence of ANAs in rheumatoid arthritis is suggestive of Felty’s syndrome

      Explanation:

      Anti-nuclear antibodies are auto-antibodies directed against a variety of nuclear antigens. There are different staining patterns and each pattern is suggestive of a different disorder.

      Speckled staining is suggestive of mixed connective tissue disease.

      Nucleolar staining is suggestive of scleroderma, while homogenous staining is suggestive of lupus.

      Anti-double stranded DNA is suggestive of SLE while anti-histone antibodies are suggestive of drug-induced lupus.

      ELISA testing is cheaper but not the most accurate means of testing for ANAs. Indirect immunofluorescence testing is the most accurate.

      The presence of ANAs in rheumatoid arthritis is suggestive of Felty’s syndrome. Felty’s syndrome is characterized by a combination of rheumatoid arthritis, splenomegaly and neutropenia.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      25.2
      Seconds

  • Question 3 - Regarding non-Hodgkin lymphoma (NHL), which of the following statements is CORRECT: ...

    Incorrect

    • Regarding non-Hodgkin lymphoma (NHL), which of the following statements is CORRECT:

      Your Answer: NHL is less common than Hodgkin lymphoma.

      Correct Answer: There is a much greater predilection to disseminate to extranodal sites than in Hodgkin lymphoma.

      Explanation:

      Non-Hodgkin’s lymphoma (NHL) refers to a group of lymphoproliferative malignancies (about 85% of B-cell and 15% of T or NK (natural killer) cell origin) with different behavioural patterns and treatment responses. This group of malignancies encompasses all types of lymphoma without Reed-Sternberg cells being present. The Reed-Sternberg cell is classically seen in Hodgkin’s lymphoma.
      NHL is five times as common as Hodgkin’s lymphoma. The peak incidence of NHL is in the 50-70 years age group, it affects men and women equally, but affects the Caucasian population more commonly than black and Asian ethnic groups.
      The following are recognised risk factors for NHL:
      Chromosomal translocations and molecular rearrangements
      Epstein-Barr virus infection
      Human T-cell leukaemia virus type-1 (HTLV-1)
      Hepatitis C
      Congenital and acquired immunodeficiency states
      Autoimmune disorders, e.g. Sjogren’s syndrome and Hashimoto’s thyroiditis
      The most common clinical features at presentation are:
      Lymphadenopathy (typically asymmetrical and painless)
      Weight loss
      Fatigue
      Night sweats
      Hepatosplenomegaly
      For clinical purposes, NHL is divided into three groups: indolent, high-grade, and lymphoblastic.
      Indolent (low-grade) NHL:
      The cells are relatively mature
      Disease follows an indolent course without treatment
      Often acceptable to follow a ‘watch and wait’ strategy
      Local radiotherapy often effective
      Relatively good prognosis with median survival of 10 years
      High-grade NHL:
      Cells are immature
      Disease progresses rapidly without treatment
      Significant number of patients can be cured with intensive combination chemotherapy regimens
      Approximately 40% cure rate
      Lymphoblastic NHL:
      Cells are very immature and have a propensity to involve the CNS
      Treatment and progression are similar to that of acute lymphoblastic leukaemia (ALL)

    • This question is part of the following fields:

      • Haematology
      • Pathology
      23.2
      Seconds

  • Question 4 - Which of the following statements about neutrophils is TRUE: ...

    Correct

    • Which of the following statements about neutrophils is TRUE:

      Your Answer: Neutrophils are typically the first immune cell to arrive to a site of injury.

      Explanation:

      Neutrophils are the most numerous peripheral blood leukocytes, accounting for 50-70 percent of all circulating white cells. Neutrophils have a compact nucleus with two to five lobes and a pale cytoplasm with an irregular shape containing numerous fine pink-blue or grey-blue granules. The granules are classified as primary, which emerges during the promyelocyte stage, and secondary, which develop at the myelocyte stage and predominate in the mature nucleus.

      The lifespan of neutrophils in the blood is only 6 – 10 hours. In response to tissue damage, cytokines and complement proteins, neutrophils migrate from the bloodstream to the site of insult within minutes, where they destroy pathogens by phagocytosis.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      25.4
      Seconds

  • Question 5 - A 56-year-old male with a 10-year history of Diabetes Mellitus and Hypertension was...

    Correct

    • A 56-year-old male with a 10-year history of Diabetes Mellitus and Hypertension was rushed to the Emergency Department due to sudden onset crushing chest pain. ECG showed an ST-elevation myocardial infarct in the left anterior descending artery territory. The patient's condition was stabilised and managed with angioplasty, but he sustained significant myocardial damage.

      Which one of the following statements best agrees with the myocardial healing process?

      Your Answer: The left ventricle will likely hypertrophy first to maintain cardiac output

      Explanation:

      Following a myocardial infarction scar tissue formation will take place at the site of the damaged muscle. This places increased load on the rest of the myocardium causing it to hypertrophy. The left ventricle will hypertrophy first as it is pumping blood against a greater afterload as compared to the right ventricle.

      There are three types of cells in the body with regards to the cell cycle: 1. permanent
      2. labile
      3. stable cells

      Permanent cells do not re-enter the cell cycle and remain in G0. If there is a pool of stem cells the stem cells will enter the cell cycle to form more cells. Myocardial cells are a type of permanent cell and there is no pool of stem cells in the heart muscle. The anterior wall will not hypertrophy as it is formed by the right atrium and ventricle and both of these hypertrophy after the left ventricle.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      33.2
      Seconds

  • Question 6 - A 24-year-old female visits her family physician to complain of painless lumps in...

    Correct

    • A 24-year-old female visits her family physician to complain of painless lumps in her neck. Her physician notes several enlarged, rubbery, non-tender cervical lymph nodes on examination. He immediately refers the patient for a lymph node biopsy, the results of which show the presence of Reed-Sternberg cells.

      What is the diagnosis in this case based on the above scenario?

      Your Answer: Hodgkin’s lymphoma

      Explanation:

      The presence of Reed-Sternberg cells is pathognomonic for Hodgkin’s Lymphoma, which is a disease-causing neoplastic transformation of lymphocytes. There is a bimodal age distribution with peaks in the 20s and 60s. Patients typically present with enlarged, rubbery, non-tender lymph nodes. Symptoms such as fever, night sweats and weight loss may be present.

      Pain after alcohol consumption is a pathognomonic sign of Hodgkin’s lymphoma, it is, however, not a ‘B’ symptom. It is rare though, only occurring in 2-3% of patients with Hodgkin’s lymphoma.
      The Ann Arbour clinical staging is as follows:
      Stage I: one involved lymph node group
      Stage II two involved lymph node groups on one side of the diaphragm
      Stage III: lymph node groups involved on both sides of the diaphragm
      Stage IV: Involvement of extra-nodal tissues, such as the liver or bone marrow
      Diagnosis is made by lymph node biopsy, which should be taken from a sufficiently large specimen or excisional biopsy, as opposed to a fine needle biopsy.

      Multiple myeloma most commonly presents with bone pain, especially in the back and ribs.

      In non-Hodgkin’s lymphoma, Reed-Sternberg cells are not present.

      Acute lymphoblastic leukaemia will present with features of anaemia, thrombocytopenia and leukopenia.

      The most common symptoms of chronic lymphocytic leukaemia are fatigue, night sweats and low-grade fever.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      21.5
      Seconds

  • Question 7 - Which of the following is NOT a feature characteristic of intravascular haemolysis: ...

    Correct

    • Which of the following is NOT a feature characteristic of intravascular haemolysis:

      Your Answer: Bilirubinuria

      Explanation:

      Features of intravascular haemolysis include:haemoglobinaemia, methaemalbuminaemia, haemoglobinuria (dark urine) and haemosiderinuria

    • This question is part of the following fields:

      • Haematology
      • Pathology
      20.4
      Seconds

  • Question 8 - Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT: ...

    Correct

    • Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:

      Your Answer: ALL is the most common malignancy of childhood.

      Explanation:

      Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. The total white cell count may be decreased, normal or increased. The blood film typically shows a variable number of blast cells. The bone marrow is hypercellular with >20% blast cells.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      13.1
      Seconds

  • Question 9 - A 57-year-old male presents to the orthopaedic clinic complaining of pain and swelling...

    Correct

    • A 57-year-old male presents to the orthopaedic clinic complaining of pain and swelling in the left knee joint. On examination, the left knee is swollen, tender and erythematous. The patient is booked for joint aspiration, and a diagnosis of pseudogout is made following the aspiration.

      Which types of crystals would be seen in the joint aspirate to lead to this diagnosis?

      Your Answer: Positively birefringent brick-shaped crystals

      Explanation:

      Gout and pseudogout are both characterised by crystal deposition in the affected joints. The deposition of urate crystals causes gout, while calcium pyrophosphate crystals cause pseudogout. The crystals can be distinguished microscopically because urate crystals are negatively birefringent needle-shaped crystals, whilst calcium pyrophosphate crystals are positively birefringent brick-shaped crystals.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      22.2
      Seconds

  • Question 10 - Which of the following is NOT a function of antibodies: ...

    Incorrect

    • Which of the following is NOT a function of antibodies:

      Your Answer: Opsonise antigens for phagocytosis

      Correct Answer: Act as antigen receptors on T lymphocytes

      Explanation:

      Antibodies:
      Neutralise toxins and prevent attachment of pathogens
      Target, opsonise or agglutinate (clump together) antigens for phagocytosis
      Activate the complement cascade (leading to lysis or opsonisation of the pathogen)
      Act as antigen receptors on B lymphocytes
      Activate antibody-dependent cell-mediated cytotoxicity by natural killer (NK) cells or T cytotoxic cells
      Provide mucosal immunity (IgA-mediated)
      Stimulate degranulation of mast cells (IgE and IgG mediated)
      Provide passive immunity to the newborn (through transplacental passage of IgG and secretion of IgA in breast milk)

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      12.1
      Seconds

  • Question 11 - A 54-year-old man who is acutely unwell has his blood sent for test...

    Correct

    • A 54-year-old man who is acutely unwell has his blood sent for test and the results come back with a CRP of 115.

      Which of these statements about C-reactive protein is FALSE?

      Your Answer: It is produced in the bone marrow

      Explanation:

      C-reactive protein(CRP) is synthesized in the liver in response to increased interleukin-6 (IL-6) secretion by macrophages and T-cells.
      Some conditions that cause CRP levels to a rise include: bacterial infection, fungal infection, severe trauma, autoimmune disease, Organ tissue necrosis, malignancy and surgery.

      It is useful in the clinical setting as a marker of inflammatory activity and can be used to monitor infections.

      CRP levels start to rise 4-6 hours after an inflammatory trigger and reaches peak levels at 36-50 hours.

      In the absence of a disease process, the normal plasma concentration is less than 5 mg/l.

      CRP is useful for monitoring inflammatory conditions (e.g. rheumatoid arthritis and malignancy), can be used as a prognostic marker in acute pancreatitis, and serial measurement can be used to recognize the onset of nosocomial infections in the intensive care settling.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      10.9
      Seconds

  • Question 12 - How does dipyridamole mediate its antiplatelet effect: ...

    Correct

    • How does dipyridamole mediate its antiplatelet effect:

      Your Answer: It is a phosphodiesterase inhibitor.

      Explanation:

      Dipyridamole inhibits both the reuptake of adenosine and phosphodiesterase, preventing the degradation of cAMP and thus blocking the platelet aggregation response to ADP.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      8.1
      Seconds

  • Question 13 - A 62-year-old woman presents with a 3-month history of lethargy and tiredness. She...

    Correct

    • A 62-year-old woman presents with a 3-month history of lethargy and tiredness. She states that she has also felt very itchy, particularly after a hot bath and that she is often dizzy and sweaty. On examination she appears plethoric and you note the presence of splenomegaly. Her blood tests today show that her haemoglobin level is 16.9 g/dl.
      What is the most likely diagnosis in this case? Select ONE answer only.

      Your Answer: Polycythaemia vera

      Explanation:

      Polycythaemia vera (PCV), which is also referred to as polycythaemia rubra vera, is a clonal haematological malignancy in which the bone marrow produces too many red blood cells. It may also result in the overproduction of white blood cells and platelets. It is most commonly seen in the elderly and the mean age at diagnosis is 65-74 years.
      Patients can be completely asymptomatic and it is often discovered as an incidental finding on a routine blood count. Approximately 1/3 of patients present with symptoms due to thrombosis, of these 3/4 have arterial thrombosis and 1/4 venous thrombosis. Features include stroke, myocardial infarction, deep vein thrombosis and pulmonary embolism.
      The other clinical features of PCV include:
      Plethoric appearance
      Lethargy and tiredness
      Splenomegaly (common)
      Pruritis (in 40% – particularly after exposure to hot water)
      Headaches, dizziness and sweating (in 30%)
      Gouty arthritis (in 20%)
      Budd-Chiari syndrome (in 5-10%)
      Erythromyalgia (in <5% – burning pain and red/blue discolouration of hands and feet)
      Increased incidence of peptic ulcer disease (possibly related to increased histamine release from mast cells)
      The diagnosis of PCV requires two major criteria and one minor criterion, or the first major criterion and two minor criteria:
      Major criteria:
      HB > 18.5 g/dl in men, 16.5 g/dl in women
      Elevated red cell mass > 25% above mean normal predicted value
      Presence of JAK2 mutation

      Minor criteria:
      Bone marrow biopsy showing hypercellularity with prominent erythroid, granulocytic and megakaryocytic proliferation
      Serum erythropoietin level below normal range
      Endogenous erythroid colony formation in vitro
      The main aim of treatment is to normalize the full blood count and prevent complications such as thrombosis. Venesection is the treatment of choice but hydroxyurea can also be used to help control thrombocytosis.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      12.8
      Seconds

  • Question 14 - A 22-year-old man arrives at the emergency department with a sore throat, low-grade...

    Correct

    • A 22-year-old man arrives at the emergency department with a sore throat, low-grade fever, and malaise. His partner has infectious mononucleosis, which was recently diagnosed. In this situation, which of the following cells is the most proliferative:

      Your Answer: Lymphocytes

      Explanation:

      Histologic findings in EBV infectious mononucleosis: Oropharyngeal epithelium demonstrates an intense lymphoproliferative response in the cells of the oropharynx. The lymph nodes and spleen show lymphocytic infiltration primarily in the periphery of a lymph node.
      Relative lymphocytosis (≥ 60%) plus atypical lymphocytosis (≥ 10%) are the characteristic findings of Epstein Barr virus (EBV) infectious mononucleosis.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      18.1
      Seconds

  • Question 15 - You examine a 78-year-old man who has been diagnosed with chronic lymphocytic leukaemia...

    Correct

    • You examine a 78-year-old man who has been diagnosed with chronic lymphocytic leukaemia (CLL).

      What is the MAIN contributory factor in this condition's immunodeficiency?

      Your Answer: Hypogammaglobulinemia

      Explanation:

      Immunodeficiency is present in all patients with chronic lymphocytic leukaemia (CLL), though it is often mild and not clinically significant. Infections are the leading cause of death in 25-50 percent of CLL patients, with respiratory tract, skin, and urinary tract infections being the most common.

      Hypogammaglobulinemia is the most common cause of immunodeficiency in CLL patients, accounting for about 85 percent of all cases.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      8.6
      Seconds

  • Question 16 - A 17-year-old male presenting in the department has a history of C3 deficiency.

    C3...

    Correct

    • A 17-year-old male presenting in the department has a history of C3 deficiency.

      C3 deficiency is associated with all of the following EXCEPT?

      Your Answer: Hereditary angioedema

      Explanation:

      C1-inhibitor deficiency is the cause of hereditary angioedema not C3 deficiency,

      All the other statements are correct

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      21.9
      Seconds

  • Question 17 - Liquefactive necrosis is most commonly seen in which of the following conditions: ...

    Correct

    • Liquefactive necrosis is most commonly seen in which of the following conditions:

      Your Answer: Ischaemic stroke

      Explanation:

      Liquefactive necrosis results in the loss of all cellular structure and the formation of a soft, semi-solid mass. This is commonly seen in the brain after a cerebral infarction.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      22.4
      Seconds

  • Question 18 - Which of the following ABO blood groups is the universal recipient: ...

    Correct

    • Which of the following ABO blood groups is the universal recipient:

      Your Answer: AB

      Explanation:

      Blood group AB has both A and B antigens but no antibodies and thus is the universal recipient.

    • This question is part of the following fields:

      • Immune Responses
      • Pathology
      5.4
      Seconds

  • Question 19 - Typically, granulomatous inflammation is associated with one of the following infections: ...

    Correct

    • Typically, granulomatous inflammation is associated with one of the following infections:

      Your Answer: Tuberculosis

      Explanation:

      Granulomatous inflammation is typically seen when an infective agent with a digestion-resistance capsule (e.g. Mycobacterium tuberculosis) or a piece of inert foreign material (such as suture or glass) is introduced into the tissue. A transient acute inflammatory response occurs and when this is ineffective in eradicating the stimulus, chronic inflammation occurs.

      Tuberculosis is the prototype of the granulomatous diseases, but sarcoidosis, cat-scratch disease, lymphogranuloma inguinale, leprosy, brucellosis, syphilis, some mycotic infections, berylliosis, reactions of irritant lipids, and some autoimmune diseases are also included

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      7
      Seconds

  • Question 20 - A dermatological examination of a patient presenting with a lump shows a visible...

    Correct

    • A dermatological examination of a patient presenting with a lump shows a visible collection of fluid measuring 0.3 cm in diameter.

      Which one of these best describes the lump you have found on examination?

      Your Answer: Vesicle

      Explanation:

      A vesicle is a visible collection of fluid measuring less than 0.5 cm in diameter.

      A furuncle, or boil, is a pyogenic infection of the hair follicle commonly caused by infection with Staphylococcus aureus.

      A carbuncle is a collection of individual boils clustered together.

      A bulla is a visible collection of clear fluid measuring greater than 0.5 cm in diameter.

      A pustule is a small visible skin elevation containing an accumulation of pus.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      16.7
      Seconds

  • Question 21 - A 60-year-old female is referred to the Oncology clinic due to the presence...

    Correct

    • A 60-year-old female is referred to the Oncology clinic due to the presence of lumps in her neck. There is a non-tender enlargement of several groups of cervical lymph nodes on examination. She is sent for a lymph node biopsy. The results show the presence of lymphoma cells, but there are no Reed-Sternberg cells.

      Which one is most appropriate for this case out of the following diagnoses?

      Your Answer: Non-Hodgkin’s lymphoma

      Explanation:

      Non-Hodgkin’s Lymphoma (NHL) causes neoplastic transformation of both B cell (85%) and T cell (15%) lines.

      The most common presentation is with enlarged, rubbery, painless lymph nodes. The patient may also have B symptoms which consist of night sweats, weight loss and fevers. Multiple myeloma most commonly presents with bone pain, especially in the back and ribs.

      The presence of Reed-Sternberg cells characterises Hodgkin’s lymphoma. Acute lymphoblastic leukaemia will present with features of anaemia, thrombocytopenia and leukopenia. The most common symptoms of chronic lymphocytic leukaemia are fatigue, night sweats and low-grade fever.

      The peak incidence of NHL is in the 50-70 years age group, it affects men and women equally, but affects the Caucasian population more commonly than black and Asian ethnic groups.
      The following are recognised risk factors for NHL:
      Chromosomal translocations and molecular rearrangements
      Epstein-Barr virus infection
      Human T-cell leukaemia virus type-1 (HTLV-1)
      Hepatitis C
      Congenital and acquired immunodeficiency states
      Autoimmune disorders, e.g. Sjogren’s syndrome and Hashimoto’s thyroiditis

    • This question is part of the following fields:

      • Haematology
      • Pathology
      27.5
      Seconds

  • Question 22 - Regarding apoptosis, which of the following statements is INCORRECT: ...

    Correct

    • Regarding apoptosis, which of the following statements is INCORRECT:

      Your Answer: Apoptosis leads to cell swelling and eventual cell lysis.

      Explanation:

      Apoptosis is a controlled form of cell death in which no cellular contents are released from the dying cell, and thus no inflammatory reaction is seen. Apoptosis may occur physiologically or pathologically. Apoptosis may be induced in two main ways: by the engagement of surface death receptors e.g. TNF-alpha (extrinsic pathway) or through cellular injury (intrinsic pathway). The end result is the activation of proteases enzymes called caspases which dismantle the cell cytoplasm and nucleus. Apoptotic cells shrink down and fragment into apoptotic bodies, each of which retains an intact cell membrane; apoptotic bodies are then targeted or rapid removal by adjacent cells. Disordered apoptosis is thought to be central to a number of important disease processes, particularly carcinogenesis.

    • This question is part of the following fields:

      • Inflammatory Responses
      • Pathology
      18.6
      Seconds

  • Question 23 - A 15-year-old male is admitted to a rehabilitation centre with a history of...

    Correct

    • A 15-year-old male is admitted to a rehabilitation centre with a history of multiple strokes, myopathy and learning disabilities since childhood. He is under the care of a multidisciplinary team, and his genetic testing reports show the presence of a mitochondrial disorder.

      Which one of the following diseases does this patient most likely have?

      Your Answer: MELAS

      Explanation:

      Mitochondrial diseases are a group of disorders caused by dysfunctional mitochondria. Most cases are maternally inherited, as we inherit our mitochondrial DNA from our mothers only, although mutations in nuclear DNA cause some cases.

      Examples of Mitochondrial Diseases include:
      1. Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS)
      2. Mitochondrial epilepsy with ragged red fibres (MERRF)
      3. Leber’s hereditary optic neuropathy (LHON)
      4. Diabetes mellitus and deafness (DAD)
      5. Neuropathy, ataxia, retinitis pigmentosa, and ptosis (NARP)
      6. Leigh syndrome (subacute sclerosing encephalopathy).

      Red-green colour blindness and G6PD deficiency have an X-linked recessive pattern of inheritance.

      Tay-Sachs Disease and spinal muscular atrophy have an autosomal recessive pattern of inheritance.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      24.5
      Seconds

  • Question 24 - A medical student is reviewing the chart of a patient who has recently...

    Correct

    • A medical student is reviewing the chart of a patient who has recently been diagnosed with leukaemia. The chief resident asks him to identify ONE feature that will most support acute leukaemia diagnosis in contrast to chronic leukaemia.

      Which one of the following options will he pick?

      Your Answer: The patient is a child

      Explanation:

      Acute lymphocytic leukaemia (ALL) is more common in children than chronic leukaemias, which generally occur in adults. Bone marrow failure occurs early on in the course of the disease in acute leukaemias, and there is the massive proliferation of undifferentiated cells with functioning cells being crowded out. Hepatosplenomegaly occurs in both acute and chronic forms of leukaemia and is not a differentiating feature.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      18.3
      Seconds

  • Question 25 - Regarding thalassaemia, which of the following statements is CORRECT: ...

    Correct

    • Regarding thalassaemia, which of the following statements is CORRECT:

      Your Answer: Screening for thalassaemia in pregnancy is offered to all pregnant women.

      Explanation:

      Beta thalassemia is caused by mutations in one or both of the beta globin genes. Alpha thalassemia is caused by a deletion or mutation (less commonly) in one or more of the four alpha globin gene copies. β-thalassaemia is more common in the Mediterranean region while α-thalassaemia is more common in the Far East.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      23.7
      Seconds

  • Question 26 - A 13-year-old male presents to the Emergency Department with a heavy nosebleed. His...

    Correct

    • A 13-year-old male presents to the Emergency Department with a heavy nosebleed. His medical record shows that he was diagnosed with Haemophilia B as a child.

      What is the mode of inheritance of this disease?

      Your Answer: X-linked recessive

      Explanation:

      Deficiency of Factor IX causes Haemophilia B, and like the other Haemophilia’s, it has an X-linked recessive pattern of inheritance, affecting males born to carrier mothers.

      Haemophilia B is the second commonest form of haemophilia and is rarer than haemophilia A. Haemophilia B is similar to haemophilia A but is less severe. You can distinguish the two disorders by specific coagulation factor assays.

      The incidence of Haemophilia B is one-fifth of that of haemophilia A.

      In laboratory findings, you get prolonged APTT, normal PT and low factor IX for Haemophilia B.

      There is also a variation called Leyden, in which factor IX levels are below 1% until puberty, when they rise, potentially reaching as high as 40-60% of normal. This is thought to be due to the effects of testosterone at puberty.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      10.6
      Seconds

  • Question 27 - While studying fluid homeostasis in the body, you encounter the term exudate. Exudate...

    Correct

    • While studying fluid homeostasis in the body, you encounter the term exudate. Exudate is a fluid that leaks out of the intravascular space due to changes in the permeability of the microcirculation secondary to inflammation.

      Which ONE of the following conditions would not be listed among the causes of an exudate?

      Your Answer: Myxoedema

      Explanation:

      An exudate is an inflammatory fluid that leaks out of the intravascular space due to increased vascular permeability and intravascular pressure. It is mostly caused by local processes and can occur in the following conditions:
      1) Infection (e.g. pneumonia)
      2) Malignancy
      3) Pericarditis
      4) Collagen vascular diseases, e.g., Rheumatoid Arthritis

      Myxoedema is a state of severe hypothyroidism in which deposition of mucopolysaccharides occurs in the dermis. This causes a transudative effusion, typically in the pretibial region.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      32.9
      Seconds

  • Question 28 - A 26-year-old male presents to your clinic with the complaint of recurrent fevers...

    Correct

    • A 26-year-old male presents to your clinic with the complaint of recurrent fevers over the past three months. On documentation of the fever, it is noted that the fever increases and decreases in a cyclical pattern over a 1-2 week period. After the appropriate investigations, a diagnosis of Pel-Ebstein fever is made.

      Which ONE of the following conditions is most likely to cause this patient's fever?

      Your Answer: Hodgkin lymphoma

      Explanation:

      The release of cytokines from Reed-Sternberg cells can cause fever in patients with Hodgkin lymphoma, which increases and decreases in a cyclical pattern of 1 to 2 weeks. This is called Pel-Ebstein or Ebstein-Cardarelli fever, specifically seen in Hodgkin lymphoma. The fever is always high grade and can reach 40 degrees or higher.

      Cyclical fever in other conditions is common but is not termed as Pel-Ebstein fever. This term is reserved only with Hodgkin lymphoma.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      19.4
      Seconds

  • Question 29 - Regarding beta-thalassaemia, which of the following statements is CORRECT: ...

    Correct

    • Regarding beta-thalassaemia, which of the following statements is CORRECT:

      Your Answer: Beta-thalassaemia trait is associated with a raised HbA2.

      Explanation:

      Beta-thalassaemia major is caused by a complete or almost complete failure of β-globin chain synthesis, severe imbalance of α:β-chains with deposition of α-chains in erythroblasts, ineffective erythropoiesis and extramedullary haemopoiesis. The severe anaemia becomes apparent at 3 – 6 months when the switch from γ-chain to β-chain synthesis normally occurs. Beta-thalassaemia minor is a variable syndrome, milder than thalassaemia major, with later onset and characterised by moderate hypochromic microcytic anaemia with raised haemoglobin A2. Beta-thalassaemia trait is characterised by mild hypochromic, microcytic anaemia with raised red cell count and raised haemoglobin A2.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      18.4
      Seconds

  • Question 30 - A 66-year-old male was admitted from the Emergency Department due to severe pain...

    Correct

    • A 66-year-old male was admitted from the Emergency Department due to severe pain in the left forearm and hand, refractory to pain medication along with pallor and hypothermia of the affected limb. Ultrasound doppler showed an arterial embolism. Circulation was restored after vascular surgery, but there was extensive, irreversible muscle damage.

      How will the muscle heal from an injury of this type?

      Your Answer: Diffuse formation of fibrous tissue

      Explanation:

      Once muscle tissue is damaged, there will be healing via diffuse formation of fibrous tissue, especially due to the widespread ischemia.

      Callus formation takes place in the healing of bone, not muscle.

      Organised scar formation occurs when a lacerated wound is approximated by sutures so that primary intention wound healing can occur.

      Liquefaction degeneration occurs following ischemia in the brain.

      Volkmann’s ischemic contracture may occur, but it is not the primary type of healing that will take place but rather the effect of the fibrous scar formation.

    • This question is part of the following fields:

      • General Pathology
      • Pathology
      25.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Haematology (13/14) 93%
Pathology (28/30) 93%
General Pathology (9/9) 100%
Immune Responses (3/4) 75%
Inflammatory Responses (3/3) 100%
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